International Journal of Hematology

, Volume 84, Issue 1, pp 79–82 | Cite as

Varicella-zoster virus encephalitis in a patient undergoing unrelated cord blood transplantation for myelodysplastic syndrome—overt leukemia

  • Kenji Fukuno
  • Akira Tomonari
  • Satoshi Takahashi
  • Jun Ooi
  • Kashiya Takasugi
  • Nobuhiro Tsukada
  • Takaaki Konuma
  • Tohru Iseki
  • Hisataka Moriwaki
  • Arinobu Tojo
  • Shigetaka Asanoa
Case Report

Abstract

Varicella-zoster virus (VZV) infection of the central nervous system (CNS) is rare after hematopoietic stem cell transplantation (SCT). Here, we describe the first patient who developed VZV encephalitis after cord blood transplantation (CBT). A 35-year-old man with myelodysplastic syndrome-overt leukemia underwent CBT. On day +23, a neutrophil count consistently greater than 0.5 X 109/L was achieved. On day +42,1 mg/kg per day of prednisolone therapy was initiated for grade III acute graft-versus-host disease (GVHD). Then, the dose of prednisolone was slowly reduced. For exacerbation of chronic GVHD, the dose of prednisolone was again increased to 1 mg/kg per day on day +231. On day +265, localized cutaneous zoster in the left thoracic region occurred, but soon resolved after acyclovir therapy. On day +309, he suddenly developed diplopia. Subsequently, right facial palsy and hearing impairment occurred. No skin rash was observed. Magnetic resonance imaging (MRI) scans revealed multifocal abnormal high-signal intensity in the CNS. A high level of VZV DNA was detected in a cerebrospinal fluid specimen. He was diagnosed with VZV encephalitis. Acyclovir was given intravenously for 40 days. Four months after the onset, the neurologic symptoms had incompletely resolved. MRI scans showed substantial resolution but with mild residual lesions. The present report indicates that VZV should be considered as a possible causative agent in patients who develop multifocal neurologic symptoms of the CNS after SCT.

Key words

Varicella-zoster virus Encephalitis Acyclovir Cerebrospinal fluid Cord blood transplantation 

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References

  1. 1.
    Locksley RM, Flournoy N, Sullivan KM, Meyers JD. Infection with varicella-zoster virus after marrow transplantation. J Infect Dis. 1985;152:1172–1181.PubMedCrossRefGoogle Scholar
  2. 2.
    Han CS, Miller W, Haake R, Weisdorf D. Varicella zoster infection after bone marrow transplantation: incidence, risk factors and complications. Bone Marrow Transplant. 1994;13:277–283.PubMedGoogle Scholar
  3. 3.
    Koc Y, Miller KB, Schenkein DP, et al. Varicella zoster virus infections following allogeneic bone marrow transplantation: frequency, risk factors, and clinical outcome. Biol Blood Marrow Transplant. 2000;6:44–49.PubMedCrossRefGoogle Scholar
  4. 4.
    Tauro S, Toh V, Osman H, Mahendra P. Varicella zoster meningoencephalitis following treatment for dermatomal zoster in an alloBMT patient. Bone Marrow Transplant. 2000;26:795–796.PubMedCrossRefGoogle Scholar
  5. 5.
    Tenenbaum T, Kramm CM, Laws HJ, Nurnberger W, Lenard HG, Gobel U. Pre-eruptive varicella zoster virus encephalitis in two children after haematopoietic stem cell transplantation. Med Pediatr Oncol. 2002;38:288–289.PubMedCrossRefGoogle Scholar
  6. 6.
    Hackanson B, Zeiser R, Bley TA, et al. Fatal varicella zoster virus encephalitis in two patients following allogeneic hematopoietic stem cell transplantation. Clin Transplant. 2005;19:566–570.PubMedCrossRefGoogle Scholar
  7. 7.
    Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ. Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med. 2000;342:635–645.PubMedCrossRefGoogle Scholar
  8. 8.
    Kleinschmidt-DeMasters BK, Gilden DH. Varicella-zoster virus infections of the nervous system: clinical and pathologic correlates. Arch Pathol Lab Med. 2001;125:770–780.Google Scholar
  9. 9.
    Gilden D. Varicella zoster virus and central nervous system syndromes. Herpes. 2004;11(suppl 2):89A-94A.PubMedGoogle Scholar
  10. 10.
    Tomonari A, Iseki T, Takahashi S, et al. Varicella-zoster virus infection in adult patients after unrelated cord blood transplantation: a single institute experience in Japan. Br J Haematol. 2003;122:802–805.PubMedCrossRefGoogle Scholar
  11. 11.
    Takahashi S, Iseki T, Ooi J, et al. Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies. Blood. 2004;104:3813–3820.PubMedCrossRefGoogle Scholar
  12. 12.
    Kronenberg A, Schupbach R, Schuknecht B, et al. Multifocal vasculopathy due to varicella-zoster virus (VZV): serial analysis of VZV DNA and intrathecal synthesis of VZV antibody in cerebrospinal fluid. Clin Infect Dis. 2002;35:330–333.PubMedCrossRefGoogle Scholar
  13. 13.
    De La Blanchardiere A, Rozenberg F, Caumes E, et al. Neurological complications of varicella-zoster virus infection in adults with human immunodeficiency virus infection. Scand J Infect Dis. 2000;32:263–269.CrossRefGoogle Scholar
  14. 14.
    Tomonari A, Iseki T, Ooi J, et al. Cytomegalovirus infection following unrelated cord blood transplantation for adult patients: a single institute experience in Japan. Br J Haemtol. 2003;121:304–311.CrossRefGoogle Scholar
  15. 15.
    Tomonari A, Takahashi S, Ooi J, et al. Human herpesvirus 6 variant B infection in adult patients after unrelated cord blood transplantation. Int J Hematol. 2005;81:352–355.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2006

Authors and Affiliations

  • Kenji Fukuno
    • 1
    • 2
  • Akira Tomonari
    • 1
  • Satoshi Takahashi
    • 1
  • Jun Ooi
    • 1
  • Kashiya Takasugi
    • 1
  • Nobuhiro Tsukada
    • 1
  • Takaaki Konuma
    • 1
  • Tohru Iseki
    • 1
  • Hisataka Moriwaki
    • 2
  • Arinobu Tojo
    • 1
  • Shigetaka Asanoa
    • 1
    • 3
  1. 1.Department of Hematology/Oncology, The Institute of Medical ScienceThe University of TokyoTokyoJapan
  2. 2.First Department of Internal MedicineGifu University Graduate School of MedicineGifuJapan
  3. 3.Integrative Bioscience & Biomedical EngineeringSchool of Science & Engineering, Waseda UniversityTokyoJapan

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